Studies of the Mechanism of Postgastrectomy Steatorrhea

Wirts, C. Wilmer

doi:10.7326/0003-4819-58-1-25

Cited by 74 publications

(8 citation statements)

References 14 publications

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“…Microbial populations of the diseased small bowel have previously been investigated by sampling the upper jejunum in fasting subjects (Goldstein et al, 1962;Wirts and Goldstein, 1963;Donaldson, 1964;Paulk and Farrar, 1964;Dellipiani and Girdwood, 1964;Tabaqchali and Booth, 1966). Although this approach has yielded useful information, the results presented in this paper demonstrate (Kalser, Cohen, Arteaga, Yawn, Mayoral, Hoffert, and Frazier, 1966), and by a direct surgical approach in man (Anderson and Langford, 1958), and in experimental animals (Gorbach et al, 1967b).…”

Section: Discussionmentioning

confidence: 74%

“…Faecal-type microorganisms may colonize the upper small intestine in patients with gastrectomy, jejunal diverticulosis, blind loops, strictures, resections, and fistulae (Goldstein, Wirts, and Josephs, 1962;Wirts and Goldstein, 1963;Donaldson, 1964;Paulk and Farrar, 1964;Dellipiani and Girdwood, 1964;Tabaqchali and Booth, 1966;Tabaqchali and Booth, 1967). These bacteria may be no more than benign 'Dr Gorbach was the recipient of training grant 5 TIAI-246, Institute of Allergy and Infectious Disease, National Institute of Health, United States PLublic Health Service.…”

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confidence: 99%

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Bacteria, bile and the small bowel

Gorbach¹,

Tabaqchali²

1969

Gut

172

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SUMMARY Microbial populations of the small bowel and bile salt metabolism were studied in 15 patients with lesions of the stomach and small intestine. These types of microorganism could be correlated with the site and extent of stasis in the small bowel and the presence of a normally functioning stomach. The presence of obligate anaerobes (bacteroides) and free bile acids could be correlated with areas of stagnation. When these abnormalities were detected throughout the small bowel, steatorrhoea was also noted. However, bacteroides and free bile acids in localized regions of either proximal or distal small bowel were generally associated with normal faecal fat excretion. Vitamin B12 malabsorption appeared to be related to the total number of bacteria colonizing the small bowel rather than to any specific type of microorganisms.The effect of antibiotics on intestinal function and bacteriology was studied in three patients. In one patient, the broad-spectrum antibiotic tetracycline was effective in eradicating an abnormal bacterial flora. In the other two, lincomycin, which is specifically effective in eradicating the anaerobic flora, restored intestinal function to normal.Under normal circumstances the lumen of the upper gastrointestinal tract in man contains low concentrations (less than 103 per ml) of predominantly Grampositive microorganisms (Van der Reis, 1925; Gorbach, Plaut, Nahas, Weinstein, Spanknebel, and Levitan, 1967b). Anaerobic lactobacilli (bifidobacterium) and Gram-negative organisms, such as coliform and bacteroides, are usually confined to the large bowel, although the distal ileum may also contain such bacteria, possibly derived by retrograde flow from the caecum. These microorganisms, however, are not normally found in the stomach and upper small intestine of healthy individuals.A luxuriant and abnormal intestinal bacterial flora may develop in association with certain diseases of the stomach and small intestine. Faecal-type microorganisms may colonize the upper small intestine in patients with gastrectomy, jejunal diverticulosis, blind loops, strictures, resections, and fistulae (Goldstein, Wirts, and

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Section: Discussionmentioning

confidence: 74%

mentioning

confidence: 99%

Bacteria, bile and the small bowel

Gorbach¹,

Tabaqchali²

1969

Gut

172

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“…Fat malabsorption is frequently observed after duodenal exclusion (13, 2h-28), such as after Billroth-I1 operations. In these instances fat malabsorption can be caused by the rapid intestinal transit time ( 12), pancreatic exocrine asynchronia (26), and bacterial overgrowth (12)(13)(14) or a combination of these potential factors. In fact, previous studies have suggested a higher prevalence of osteopenia in Billroth-11-operated patients compared with those having a gastroduodenostoniy (1 8).…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis after Total Gastrectomy Results of a Prospective, Clinical Study

Liedman

Bosæus

Mellström

et al. 1997

Scandinavian Journal of Gastroenterology

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“…Why should some and not all patients with a gastrojejunostomy remain colonized? It has been suggested that the length of the afferent loop influences the incidence of colonization (Wirts and Goldstein, 1963). The length of the afferent loop in those who were colonized was 6-5 ± 0-8 cm against 6-4 ± 20 cm in those who were not colonized (mean ± 1 standard error).…”

Section: Discussionmentioning

confidence: 99%

The effect of vagotomy and drainage on the small bowel flora

Browning¹,

Buchan²,

MacKay³

1974

Gut

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SUMMARY The incidence of small intestinal colonization in unoperated duodenal ulcer patients was low and similar to that in the normal population. The majority of patients seven to 10 days following truncal vagotomy and drainage were colonized whereas none of a control group of patients following simple closure of a perforated duodenal ulcer was colonized. In patients with pyloroplasty, this high incidence fell to control levels on average 18 months postoperatively, but in patients with a gastrojejunostomy, the incidence remained raised probably due to the presence of the afferent loop.Only two patients developed episodic diarrhoea and there was no obvious association with small bowel colonization.

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Studies of the Mechanism of Postgastrectomy Steatorrhea

Cited by 74 publications

References 14 publications

Bacteria, bile and the small bowel

Bacteria, bile and the small bowel

Osteoporosis after Total Gastrectomy Results of a Prospective, Clinical Study

The effect of vagotomy and drainage on the small bowel flora

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